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TRANSCRIPT
1 Revised: 8/16/2011
Electronic Medication Reconciliation
and Depart Process Overview
Nursing Deck
Introduction
2
To achieve the highest standard of care that our system aspires to, as well
as to meet the reporting requests of multiple regulatory agencies, new
functionality/enhancements have been developed in Cerner.
This presentation will illustrate the following:
• Document Medications by Hx
• Electronic Medication Reconciliation
• Depart Functionality (including Medication Reconciliation, Discharge
Meds/Prescriptions, Diagnosis, Discharge Details, Discharge Depart
Order, Discharge Instructions/Education,
Follow-up and Medication Leaflets).
3
Table of Contents Medication Reconciliation will be electronic. The old discharge process will be replaced with
a new process. Several changes will occur in PowerChart as a result. The following slides
will walk you though the changes: ELECTRONIC MEDICATION RECONCILIATION, and
the NEW DEPART PROCESS. You may view the slides in order by pressing the Page
Down key, the Enter key, or the Space bar on the computer keyboard.
Document Medications by Hx Overview — Slide 4
Document Medications by Hx — Slide 5
Admission Medication Reconciliation — Slide 14
Accessing the Depart Icon — Slide 18
Depart Process Window Overview — Slide 20
Completing the Depart Process—Provider Only Actions — Slide 27
Discharge Medication Reconciliation — Slide 29
Discharge Prescriptions — Slide 30
Discharge Details — Slide 31
Discharge Depart Order — Slide 35
Completing the Discharge Process— Provider and Nurse Actions — Slide 38
Discharge Instructions/Patient Education —Slide 39
Reviewing Discharge Instructions —Slide 42
Follow up — Slide 48
Medication Leaflets — Slide 53
Patient Summary Overview — Slide 55
Clinical Summary Overview — Slide 63
Document Medications by Hx Overview • Must be completed within 90 minutes from the decision to admit
• Has been removed from the Admission Assessment form
• Document compliance on all medications including prescriptions (pill
bottles)
• If unable to complete Document Medications by Hx an option is now
available to mark the list “Leave Med History Incomplete-Finish Later”
• Accuracy and completeness are paramount when documenting drug,
dose, route, frequency and compliance. Providers will use this list to
complete the electronic admission medication reconciliation and medication
orders. Compliance details are easily visible to Providers.
• When the decision to admit is made, two tasks will now fire to the nurse task
list
• Document Medications by Hx - Rule (must be completed by nursing
within 90 minutes admission)
• Admission Assessment - Rule (must be completed by nursing within
24 hours of admission)
• For a detailed description of Document Medications by Hx Click on the
following link.
Document Medication by Hx
•
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Document Medications by Hx- Rule Task
Double clicking on the Document
Medications by Hx - Rule Task
will open the Document Medications by Hx
Form.
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Document Medications By Hx Form Click on the Document Medication by Hx button.
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In the Find field, type in the medication name. Select the medication
name that does not have dose information attached. An Order
Sentences window will display, select the route and dose that match
what is reported by the patient.
Document Medication By Hx
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8 Status bar will
update
Status Bar: Complete Incomplete
Next, the Details window will open. Continue to fill in or modify any details. You may also enter Order
Comments if needed on the next tab. The last tab is the Compliance tab. Information should be entered
on the Compliance tab for new medications as well as updated for medications that pulled in from
previous encounters. When finished, click on Document History.
Document Medication By Hx
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It is then necessary to sign the
form by clicking on the green
check mark.
Modifying Compliance-Prescriptions(pill bottles)
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Nursing is responsible to Add/Modify compliance for prescriptions. It
is the responsibility of the nurse to review prescription medications
with the patient. It is no longer necessary to re-enter these
medications however, you must now Add/Modify Compliance for all
prescription medications.
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Med History Incomplete – Finish Later
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Leave Med History
Incomplete-Finish Later was
added for nursing to indicate the
Med Hx is incomplete. The
status bar will not display a
green check mark.
If unable to complete the Document Medication by Hx, place a check mark
in the box Leave Med History Incomplete-Finish Later. Click Document
History. This will not place a green check mark on the Status bar for Meds
History.
10
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Document Medication By Hx
Once a check mark is placed in the box indicating, Leave Med History
Incomplete-Finish Later, the nurse must hover over the status bar to
retrieve the Incomplete status information. The Leave Med History
Incomplete-Finish Later box is no longer on view on the Document
Medication Hx Window.
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Medication: Status Bar
Medication History Details
Reconciliation
History
The Status Bar indicates when Meds History, Adm. Meds Rec and
Disch. Meds Rec have been completed.
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Nurses must complete the “Document Medication by Hx” (patient’s home
medication list) within 90 minutes from the decision to admit.
Status Bar:
Complete
Incomplete
Click on the Medication List to view medication information.
The Benefits of Medication
Reconciliation
• Transitioning from a paper process to an electronic
process completed by Provider (Physician, PA and
CRNP)
• Home medications are easily converted to admission
orders
• Home medications and inpatient orders can be easily
converted to prescriptions
• Ensures a more complete medication list for discharge
• Discharge medication list available electronically when
patient returns (Document Medication by Hx will be
updated with new medication list)
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Admission Medication
Reconciliation
14
Compliance icon -
Patient is not taking
Prescription
Documented
Medication by Hx
(home med)
Orange asterisk-
unreconciled meds
Icon guide
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Reconciliation button available to
Providers only
Admission Medication
Reconciliation
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The Provider can hover over the compliance icon to display
the details of the medication compliance.
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Admission Meds Reconciliation
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Unreconciled Order(s) button: Indicates
the number of unreconciled medications.
Continue: Will convert to Inpatient Medication. Click radio button
under continue and medication will display under Medications After
Admission Reconciliation.
Do Not Continue :
•Leaves Documented Meds by Hx as Documented
•Leaves Prescriptions as Ordered
Benefits of Depart Process
17
• Can begin the depart process at any time during the patient stay (as early as day of
admission).
• Providers are able to complete discharge Medication Reconciliation, Discharge
Meds/Prescriptions including printing prescriptions, Diagnosis, Discharge
Details, Discharge Instructions/Education and Follow-up Information.
• Nurses are able to complete Discharge Instructions/Education, Follow-up
Information and print Medication Leaflets.
• Process may be started/stopped at any time. Multiple Providers can contribute to the
document. Document may be saved by selecting Sign/Close.
• Consulting physicians may enter their follow-up information before the patient has been
discharged. That information will pull into the Discharge Instructions which is a huge
benefit for physicians so that patients receive correct follow-up information for all
consulting physicians.
• CORE/Quality Discharge instructions such as CHF, Stroke and Warfarin will automatically
pull into the new format.
• Multiple discharge instructions can be incorporated in the patient instructions, however,
these instructions need to be reviewed to eliminate conflicting information (for example
diet and activity). This is the responsibility of both the Provider and the Nurse.
• The actual Discharge Depart order can be done at a later time - this is the final step.
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Customizing the Toolbar to Access the Depart Icon
• The Depart icon is located in the Actions Toolbar. In order to see the Depart
Icon, you will need to customize it to your view.
• You can expand the toolbar by clicking on the arrow at the end of the toolbar to
see all the icons.
• To move the icon on the toolbar, click on the arrow located at the right edge,
hover over Add or Remove Buttons, and select Customize. While the Customize
Toolbars window remains open, click on the icon and drag it to the preferred
position.
For more information on customizing the toolbar, click on the following link.
Customizing Toolbars
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Accessing the Depart Icon
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The Clinical Note will no longer be used for discharge.
Providers (Physicians, CRNPs, and PAs) will now be
ELECTRONICALLY entering patient discharge action items
including: medication reconciliation and creating a final medication
list, discharge meds /prescriptions (printing electronic
prescriptions), diagnosis, and any other details or orders related to
discharge using the Depart icon on the Actions Toolbar.
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To open Depart, click on the Depart icon from the Toolbar.
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When you click on the Depart icon, the Depart window will open:
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Once the Depart window is open, action items
will be displayed on the left. You will notice
highlighted options - •Provider Only Actions
•Provider & Nursing Actions
•Nursing Only Action
The Provider will complete the first group of
action items, the Provider and/or Nursing will
complete the second group, and Nursing will
complete the third group.
Notice the blue circles in front of each action item. If an action item has not been started,
it will be empty. If it has been started, but not completed, it will be half full. A full circle
indicates that action item has been completed.
Changing from an empty circle to a half full one is automatic. However, the full circle is
dependent on the user clicking on it when the action item is completed.
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Not Started
Started
Completed
To complete the Depart Process, users will open and enter information into
each action item. To open an action item, click on the icon on the right.
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On the right, you will see two tabs Patient Summary and Clinical Summary.
The default is the Patient Summary Tab. As action items are completed on
the left, the Patient Summary will be created. These are the discharge
instructions that will be printed and given to the patient.
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The Clinical Summary Tab - As action items are completed on the left, the
Clinical Summary will also be created. This is the discharge information
that will be printed and sent with patients who are discharged to other
facilities.
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25
Current State – Sign -creates a
final document which cannot be
edited
Current State – Clinical Note
Future State – Depart Process Future State – Sign/Close stores
the document and allows for future
modification
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To sign the documentation click on Sign/Close button. Selecting the X will
cause the documentation to be lost.
Signing the Depart Process
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27
Completing the Depart Process -
Provider Only Actions
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Providers will complete Medication Reconciliation and Discharge
Meds/Prescriptions. As providers complete Medication Reconciliation the blue
circle will be filled in. As Diagnoses are added, they will be listed below the
action item on the left.
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Provider Only Actions
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Return to Table of Contents
Discharge Medication Reconciliation
Continue After Discharge: Documented Medication remains as “Documented” –
No Prescription is created.
Create New Rx: Creates New Prescription.
Do Not Continue After Discharge: Discontinues Document Medication by Hx – no
longer on patients profile
Continue After Discharge and Create New Rx for Inpatient Medications that have NOT been verified
by Pharmacy will be grayed out (dithered).
Discharge Prescriptions
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Providers will now be creating electronic prescriptions for medications,
labs, DME and radiology. These prescriptions will print to the default
printer attached to the PC and require a signature by the Provider.
Prescriptions must be signed by Provider
Discharge Details – Provider Only Action
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Current state — Discharge Order with 6
required fields (must be placed when
patient ready for discharge).
Future state — Activity, Diet, and Disposition
(along with other non-required details) can be
started ahead of time.
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The Discharge Details window will open to the Depart Discharge Form. The
Provider will select appropriate details for the patient. Required fields include:
Activity, Diet, and Disposition and are highlighted in yellow.
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Additional Discharge Instructions can be provided by selecting radio
buttons at the bottom of the form (not required).
Disposition
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Current State - Facilities use various processes (paper and electronic) when
patients are discharged to Post Acute Facilities or Behavioral Health Units.
Future State -When Skilled Nursing Facility or WPIC-Inpatient BHU are
selected under Disposition, another section will open for Provider to
complete.
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Orders for Next Facility
The following information will pull-forward from the
Admission Assessment:
•Pneumonia vaccine administered
•Pneumonia vaccine date/time
•Flu vaccine
•Flu vaccine administered
•Flu vaccine date/time
•Healthcare Decision Maker (s) name and phone number
The additional section contains the
necessary information required by
the facility the patient is being
discharged to. Once information is
selected use the “circle back” button
to return to the main section.
Discharge Depart Order
35
The final Provider Only action item is Discharge Depart Order.
The discharge order (Discharge Depart Order) is the last step in
getting the patient discharged. If the patient is ready to leave when the
Provider is completing the depart process, the Provider can enter that
order from here (Discharge Depart Order action item).
OR
If the depart process has been completed in advance, this order can be
entered from the order matrix.
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Future State: Entering the Discharge Depart Order without details will be the last step to let
nursing know the patient can leave the hospital.
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Current State: Completing the Discharge Order with all the details such as activity, diet,
follow up etc. is the first step when discharging a patient and is not entered ahead of time.
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Clicking on the Discharge Depart Order action icon will
open the Add Order window. This order will be entered when
the patient is ready to leave the hospital. The order has 3
fields — Requested Start Date/Time, Special Instructions,
and IV Therapy (Remove IV). There are no required fields.
Entering the Discharge Depart
Order
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The first Provider & Nursing action item is Discharge Instructions/Education.
Completing the Discharge Process -
Provider & Nursing Actions
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Future State – Clicking on the Discharge Instructions/Education action item will open the Patient Education window.
Providers and/or Nursing can add the Discharge instructions from here.
Current State – The Discharge Instructions Form is a multi-select PowerForm used by Providers and Nursing.
Discharge Instructions/Education
40
Once the Patient Education window opens, a search field and several
buttons across the top of the tab will display.
• “Suggested” instructions may display based on the diagnosis entered by the
Provider.
• Click on All and type in the instruction you are looking for in the search field, all
results will display in the window below alphabetically. Double-click on desired
instructions.
• “Departmental” and “Personal” allow you to save “favorite” type instructions. All
allows you to search all the instructions in the system.
.
Return to Table of Contents
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Double click on selected
instructions on left to display in
the window on right. As you
add instructions, all the ones
that you have chosen will be
listed to the left.
Searching Discharge Instructions Using All Function
Reviewing
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Review the discharge instructions by checking the Patient Summary. Review for conflicting information
(such as diet and activity) and redundancy. Discharge instructions cannot be modified from inside the
Patient Summary. Modifications must be made by opening the action items Discharge Details or
Discharge Instructions/Education. If making changes to Discharge Instructions/Education, these forms
can be treated like Microsoft Word Documents and modified as such.
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Please be aware that certain
Discharge Instructions/Education
cannot be modified due to quality
measures. Examples include:
CHF, stroke, warfarin and VTE.
Reviewing When Provider chooses a diet
from the Depart Discharge
Powerform, the selection will
appear under “What should I
eat?” in the Patient Summary.
In this example the Regular diet
has been selected.
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When a Provider selects a discharge instruction there may be a diet associated with that
instruction that will appear on the Patient Summary.
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Reviewing
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Reviewing
Conflicting diets are noted on the “What should I eat?”
section and the Discharge Instruction section of the
Patient Summary.
After discussing the conflict
with the Provider, the Provider
or Nurse can modify the
discharge details by clicking
the Discharge Detail action
icon contained in the Provider
Only Actions section.
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Modifying Conflicting Data
Once the Discharge Details Powerform
opens, deselect the conflicting diet (in this
example the Regular diet has been
deselected) and select the See
Diagnosis/Procedure Specific Instructions
option. See Diagnosis/Procedure Specific
Instructions now displays in the “What
should I eat?” section in the Patient
Summary. Sign the Powerform using the
green checkmark (not shown).
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As Discharge Instructions are added, they will be listed under the action
item on the left.
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Follow-Up Information
48
The second Provider & Nursing action item is Follow-up Information.
This is where a consulting physician can add follow up information for a
patient prior to the patient’s actual discharge. Follow up information can
be added at anytime.
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The Follow-Up Information window will open. Providers and/or Nursing can
add Follow-up details.
• Who – Search by Provider, Organization/Clinic, or add Free Text
information
• When – Date/Time
• Where – Providers or Organizations/Clinics, business addresses will
automatically populate
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The check mark next to the address will indicate that it will be included in the
patient discharge instructions. If you do not wish to include it, uncheck the
box.
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To add a new address, click
on Add Address and a new
window will open to
complete.
The new address
will now display.
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A reason for follow up may be added by using the Quick Picks or
Predefined Comments.
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The default for follow-up appointment will be with
the patient’s PCP in 1 week.
Sign will add the information to the Patient Summary.
Print will give you the ability to print the Patient
Summary at this point in the depart process.
Cancel will exit Follow-up Information without any
actions.
To choose a Predefined
Comment, double click on
the comment. It will now
appear in the Edit Comments
box. If you need to modify
the Predefined Comment
update as needed within the
Edit Comments box.
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As Follow-up Information is added, it will be listed under the action
item on the left.
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Selecting Medication Leaflets opens the Medication Leaflet window.
Medication Leaflets
The Nursing Only action item is Medication Leaflets.
Medication Leaflets can still be printed from the eMar and Medication
Administration Wizard.
54
Type medication in search field and click the ellipsis button to search. The
Medication Leaflet will display.
Selected instruction will display under the Selected Leaflets to the left. Previously
selected instructions will display to the right.
Medications Leaflets
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It is important to print medication leaflets from this window.
The medication leaflets do not print with or save to the patient summary.
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Patient Summary Overview
As action items are completed they pull to the Patient Summary. The next
slides will highlight selected information.
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Reviewing Patient Summary - Medicines
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When Medication
Reconciliation
is complete the
medications will pull
to the Patient
Summary in the grid
format.
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Patient Summary- Medicines
Medications will be listed in grid format
• Home Medications to be taken in the Morning
• Home Medications to be taken in the Afternoon
• Home Medications to be taken in the Evening
• Home Medications to be taken at Bedtime
• Home Medications to be taken As Needed
• Medications That You Should Stop Taking
• Medication List Summary
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Patient Summary-Medicines
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Patient Summary-Medicines
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“What is my main
Medical problem?” is
added when the
provider selected the
diagnosis.
“When are my
appointments?” is
added when the
provider selected follow
up.
“Activity/Exercise and
What should I eat”
comes from the
Powerform the provider
completed.
Allergies are pulled from
documentation.
Patient Summary
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Home Care information
pulls from Home Care
documentation (not
shown).
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If there are any topics that you need
to add, you can add free text
information by clicking on the blue
hyperlink Visit Information
Comment (see below).
A box will open where you can add what is
needed. Then Click ok and it will display in
the patient summary.
Information pulls from the
Discharge Depart
Powerform completed by
the Provider.
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Printing Patient Discharge Materials
62
• Print Patient Discharge Summary or Clinical Summary
• Patient Discharge Summary signature sheet - requires a patient’s
signature and this sheet is to be placed in the chart
• Print My UPMC Safe Discharge
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63
• The Clinical Summary
contains information that
will be used by other
clinicians
• This document will be
printed when a patient is
discharged to all outside
facilities (LTAC, SNF,
BHU, and Rehab)
• At the top is patient
demographic data,
providers and medical
information
•This is followed by last
charted vital signs, final
medication list, meds
given today
Clinical Summary Overview
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Clinical Summary
• PendingTests/Exams,
Order Information,
Patient Education/
Follow Up, Home
Health Care
Information
• You will see an
Additional Comments
hyperlink. If you click
on the hyperlink, you
will get a pop up box
where you can free
text information (Not
Shown.)
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• When ready to print,
click the print option in
the lower right corner.
You have reached the end of this presentation. Thank you for
taking time to review.
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